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Can Chronic Kidney Disease Cause Type 2 Diabetes?

Jul 16, 2019
 
Editor: Steve Freed, R.PH., CDE

Author: Kassey  James, Pharm.D. Candidate, LECOM School of Pharmacy

A new study examines why type 2 diabetes incident rate is higher in patients with chronic kidney disease: does kidney disease cause diabetes?

Diabetes and chronic kidney disease share common risk factors, leading us to question whether patients with chronic kidney disease are at an increased risk for type 2 diabetes. There is a lack of research in this area, and although there are numerous diabetic prediction models, none have been developed for patients with chronic kidney disease that are not in end stage renal disease. To further complicate this issue, the appropriate glycemic control measurement has not been established in the setting of chronic kidney disease. This observational cohort evaluated patients with chronic kidney disease to determine the unadjusted incidence of type 2 diabetes, study various measures of glycemic control in this population, identify risk factors, and assess predictive performance models.

The prospective cohort included 1,713 participants with complete data and 162 with partial data who had reduced glomerular filtration rates without diabetes at baseline. Of the 1,713 participants, 1,402 were considered normoglycemic, and 311 as having pre-diabetes. 203 of the 1,713 participants developed type 2 diabetes. The overall unadjusted incidence rate for type 2 diabetes was 17.8 cases per 1,000 person-years. Participants with baseline fasting levels less than 100 mg/dL had a rate of 12.7, and those with a rate between 100 and 125 mg/dL had a rate of 46.5. The unadjusted rate for type 2 diabetes was higher in participants whose baseline fasting level was greater than 100 mg/dL.

When comparing different measures of glycemic control, a higher percentage of participants were categorized as having pre-diabetes when using a single HbA1c measurement. When considering all indicators of glycemic control, higher values were associated with a greater incidence of type 2 diabetes. Conversely, the two indicators of kidney function and damage were not associated with an increased risk of type 2 diabetes.

Evaluating the predictive performance models, the addition of a single indicator of glycemic control improved predictive models. These include fasting blood glucose, HOMA-IR, and HbA1c. The inclusion of one of these indicators plus a fasting blood glucose level further improved predictive performance. This study found the unadjusted rate of incident type 2 diabetes for patients with chronic kidney disease to be significantly higher than the general population. This association could be because chronic kidney disease and diabetes share common risk factors. A universal standard of glycemic measurement is needed in this patient population because confounders may affect the accuracy of HbA1c assay and HOMA-IR. This area needs future research to improve evaluation of these patients.

Based on this cohort, participants with chronic kidney disease were not significantly associated with an increased risk of type 2 diabetes, although insulin resistance is a common feature found in patients with chronic kidney disease. This data shows that association does not necessarily suggest predictive unity. 

Limitations of this study include: low number of events observed, low power of the study, limiting predictors for baseline measurement, and not all risk factors were measured in this study. Predictive models of type 2 diabetes risk among patients who were normoglycemic at baseline, kidney function and damage were not linked to diabetes. Baseline glycemic level and family history were the only predictive factors of significance in this study.  Although an association was not found in this prospective cohort, greater preventive measures should be used in this population due to a higher rate of diabetes.

Practice Pearls:

  • No significant association was found between measures of kidney function and damage in predicting incidence of type 2 diabetes.
  • The rate of incidence of type 2 diabetes in patients with chronic kidney disease is significantly higher than the general population and this could be because they share risk factors.
  • Further research is needed and should include more risk factors and a universal standard of glycemic measurement for patients with chronic kidney disease.

 

Reference for “Can Chronic Kidney Disease Cause Type 2 Diabetes?”:

“Incident Type 2 Diabetes Among Individuals With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.” American Journal of Kidney Diseases, W.B. Saunders, 1 Sept. 2018, www.sciencedirect.com/science/article/pii/S0272638618308230.

 

Kassey James, Pharm.D.Candidate, LECOM School of Pharmacy